BACKGROUND & AIMS:
:We propose rituximab as a first-line therapy for pemphigus vulgaris and steroid-dependent bullous pemphigoid with or without systemic steroids. A brief review of the literature substantiates the significant risk associated with the use of long term, high-dose prednisone, mycophenolate mofetil (MMF), and azathioprine. No head-to-head studies are available with respect to safety and efficacy of rituximab versus these therapies. When comparing the side effects of rituximab to MMF, both are found to be mild when used as monotherapy in dermatologic patients. The most severe side effects of rituximab include fatal infusion reactions and hypersensitivity, pancytopenia, infection and organ dysfunction. With MMF, malignancy, pancytopenia, infection, and organ dysfunction are the most concerning side effects. The frequencies of these observed adverse events are difficult to compare, but the side effect profiles of rituximab and MMF are clearly similar. Therefore, there is equipoise whether to use rituximab before rather than after MMF and/or systemic corticosteroids.
背景与目标:
:我们建议使用利妥昔单抗作为寻常性天疱疮和类固醇依赖性大疱性类天疱疮的一线治疗,无论是否全身性使用类固醇。对文献的简要回顾证实了长期使用大剂量泼尼松,霉酚酸酯和硫唑嘌呤会带来重大风险。目前尚无关于利妥昔单抗相对于这些疗法的安全性和有效性的正面研究。当比较利妥昔单抗与MMF的副作用时,在皮肤病患者中作为单一疗法使用时,发现两者均较轻。利妥昔单抗最严重的副作用包括致命的输注反应和超敏反应,全血细胞减少,感染和器官功能障碍。对于MMF,恶性,全血细胞减少,感染和器官功能障碍是最令人担忧的副作用。这些观察到的不良事件的发生频率很难比较,但是利妥昔单抗和MMF的副作用曲线非常相似。因此,是否在MMF和/或全身性皮质类固醇之前而不是之后使用利妥昔单抗是有平衡的。